Remote Utilization Management Nurse (LPN/LVN) - UM & Appeals

Integra Partners; Yorktown (VA); On-site; USD 54,000 - 66,000; Full time

Benefits offered by this job

Competitive compensation

Annual bonus program

401(k) retirement program with company

Company-paid life insurance

Short term disability coverage

Medical, Vision, and Dental benefits

Paid Time Off

Paid Parental Leave

Sick Time

Paid company holidays and floating

Quarterly company-sponsored events

Health and wellness programs

Career development opportunities

Job summary

Integra Partners in Virginia seeks an experienced LPN/LVN to perform pre-service and post-service utilization reviews and appeals for DMEPOS within an NCQA-compliant UM program.

You will collaborate with the Medical Director, interpret medical necessity criteria, and communicate review outcomes in writing and verbally. This role offers competitive compensation, benefits, and opportunities to contribute to high-quality home healthcare management.

Qualifications

• Active LPN/LVN license required.
• Minimum 3 years nursing experience in acute/outpatient settings.
• UM experience in managed care/payor environment preferred.
• Experience with Medicare/Medicaid and UM authorizations highly desirable.
• Ability to interpret medical necessity criteria and communicate decisions clearly.
• Strong written and verbal communication skills.

Responsibilities

• Perform pre-service and post-service UM reviews and appeals for DMEPOS.
• Collaborate with Medical Director on benefit and medical necessity reviews.
• Communicate outcomes of UM reviews verbally and in writing.
• Ensure compliance with NCQA, CMS and state standards.
• Coordinate with non-clinical team to obtain supplemental information.
• Refer complex cases to Medical Director or IROs as needed.

Skills

UM authorization reviews

Communication skills

Teamwork

Organizational skills

Adaptability

Education

Licensed Practical Nurse (LPN)

Tools

InterQual

CMS guidelines

NCQA standards

DMEPOS knowledge

Job description

Integra Partners in Virginia seeks an experienced LPN/LVN to perform pre-service and post-service utilization reviews and appeals for DMEPOS within an NCQA-compliant UM program.

You will collaborate with the Medical Director, interpret medical necessity criteria, and communicate review outcomes in writing and verbally. This role offers competitive compensation, benefits, and opportunities to contribute to high-quality home healthcare management.